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Evaluation of Department of Defense hospital antimicrobial stewardship programs (ASPs) using a novel Core Elements scoring approach and modeling Core Elements scores with metrics related to ASP outcomes

Published online by Cambridge University Press:  13 March 2025

LeeAnne C. Lynch Open the ORCID record for LeeAnne C. Lynch [Opens in a new window] ,
Katrin Mende ,
Rana F. Hamdy Open the ORCID record for Rana F. Hamdy [Opens in a new window] ,
Cara H. Olsen Open the ORCID record for Cara H. Olsen [Opens in a new window] ,
Paige E. Waterman Open the ORCID record for Paige E. Waterman [Opens in a new window] ,
John M. Young Open the ORCID record for John M. Young [Opens in a new window]  and
David R. Tribble Open the ORCID record for David R. Tribble [Opens in a new window]
LeeAnne C. Lynch*
Affiliation:
Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
Katrin Mende
Affiliation:
Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA
Rana F. Hamdy
Affiliation:
Children’s National Hospital, Washington, DC, USA George Washington University School of Medicine and Health Sciences, Washington, DC, USA
Cara H. Olsen
Affiliation:
Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
Paige E. Waterman
Affiliation:
Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
John M. Young
Affiliation:
Virginia Military Institute, Lexington, VA, USA
David R. Tribble
Affiliation:
Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
*
Corresponding author: LeeAnne C. Lynch; Email: leeanne.c.lynch@gmail.com
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Abstract

Objective:

Evaluate Department of Defense (DoD) antimicrobial stewardship programs (ASPs) by assessing the relationship between key clinical outcome metrics (antibiotic use, incidence of resistant pathogens, and incidence of Clostridioides difficile infections) and CDC Core Element (CE) adherence.

Design:

Retrospective, cross-sectional study of DoD hospitals in 2018 and 2021

Methods:

National Healthcare Safety Network Standardized Antimicrobial Administration Ratios (SAARs) were used to measure antibiotic use and microbiology results to evaluate four types of pathogen incidence. A novel CE scoring approach used scores to quantitatively assess relationships with CE adherence and outcome metrics using correlation and regression models. Assessments were repeated with 2021 data for Priority CE adherence and to conduct adjusted regressions for CEs and Priority CEs controlling for categorical bed size.

Results:

Compared to 2022 national data, DoD hospitals in 2021 had a similar proportion of facilities with a SAAR statistically significantly > 1.0. Leadership, Action, and Tracking CEs followed a more normal score distribution, while Reporting and Education were somewhat left-skewed. Unadjusted models often showed a positive relationship with higher CE scores associated with worse outcomes for the SAAR and pathogen incidence. Adjusted models indicated that procedural CEs, particularly Priority Reporting, were associated with better ASP-related outcomes.

Conclusions:

CEs should be more quantitatively assessed. Results provide initial evidence to prioritize procedural CE implementation within the DoD; however, additional investigation for structural CEs is needed. Patient outcome data should be collected as an important indicator of ASP performance.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 46 , Issue 5 , May 2025 , pp. 526 - 536
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

These results were presented at the Infectious Disease Clinical Research Program’s Science Symposium in Bethesda, MD on 13 March 2024.

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